The URL can be used to link to this page

Home My WebLink About6023-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certi[icate O[ Occupancy THIS CERTIFIES that the building located at..~.~... (~?. ~.: . .~..,..t~t~-. Street Map No .... ~" ....... Block No...)~ ....... Lot No.../~ ....... U/'~'~~.. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...~. ~) .... , 19.~. ? pursuant to which Building Permit No dated ..~/'IL o. -~'~'' ~..[ ...... , 19~., was issued, ~d conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .~.~.. ~...~~... ~. { ............... ~ [/ / (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . ~ .~ ~.. [ ~: ~. ~. ~ ~, HOUSE NU~" ~Y~ Street ~ t~ , ~ Building Inspector FORM' NO. ~ TOWN OP SOUTNOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT COMPLETION OF THE WORK AUTHORIZED) No.` 6023 Z Date ......................... .Jti~]r. ......... ~.~ ...... , J 9.~C~.. Permission is hereby granted to: Jeffery Srith ............ P';O';~'"'~ ....................................... .................. .B:l. wexb. emS, ..~ .3:, ......................... to ..$.u~f,..x~..or~e...f~...d~ze~ ~£ .................................................................................... at premises located at ...... ~-//~..]~-u,t~f~'l..~'V~ ................................................................................. ................................................... ~ ~t ehc~,ue ..-. t~';if '~ ......................................................................... pursuant to application dated .......................... ~'.llr~...P.O ............. , 19~:...., and approved by the Building Inspector. Fee $..~.~.~. ......... TOWN OF SOUTHOLD Building Depa~ment Town Clerics Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in triplicate to the Building Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2.Final approval of Health Dept. of water supply and sewerage dispcsal--(S-9 form or equal). 3.Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5.Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic features. 2.Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1,00 .~ Date .. ~...~....O......./....~..:.~....~;';T... New Building .................... OLd or Pre-existing Building ............................ Vacant Land ............................ Owner Or Owners Of Propert' y ..~.....~ ......... ii.iii ......................... Su ivision ........ .................................................. ,or No ....... House Permit No....'.~....~...~...~.... Dote Of Permit~..~../...~./~p cant ~..~.....~ ;..~..='. .......... Health Dept. Approval .~..~..../..~..'~....~... ............. Labor Dept. Approval .....Z~......~..C.. ................... Underwriters Approval ~........~.~J,. ......................... Planning Board Approval ../..-.. ................................. Request For Temporary Certificate ........................................ ' Final Certificate Fee Submitted $ .r~...; ........ .~... ............... Construction on above described building~ p;~,mi~.m;ets all a~_l~le_~gd regulations. Sworn to before me this ..... .~.....C:?... day of ........~..,../~......~.~..~...~... (stamp or seal) Notary Public~.~...t~..-~;~[~ County TERRI LEE El_AK ~i0TARY PUBLIC, State 0t New ~rk No. 52-6168295 Qualified in Suffolk County Commissiofl Expires March $0, le 7~ BUILDING DEPARTMENT ~-~'~.., TOWN CLERK'S OFFICE ~ ~ SOUTHOLD, N.Y. -- '---- - Examined ....~ ..................... , 19 ........ ~ ~. ~ A Dlicotion No, ...~..~ , . , , , PE ...... ~proved ...~ .................................. , 19 ........ Pem~tNo...~ ........~..~...~ ..... . ............................................................................ ~U~TIO~ ~R 8~1~ ~[R~IT Date ' J~e 20 . , ~ ~ ~ .:.:.~ ......... ~. .............................. 19. INSTRU~IONS a. This application mu~t ~ compl*t~lg fillod in bg t~p~writ*r or in ink and submitt*d in triplicate to the Buildin~ In*~ector, wit~ 3 s,ts of ~lan~, aecurat~ plot ~lan to ~cale. Fee aceordinfl to schedule. b. Plot ~lan ~howin~ location of lot and of buildin~ on pr~mis~, relationshi~ to ad~oinin~ premi~os or public streets or areas, and~ ~ivin~ a d~tail~d do~cri~tion of lago~t'of pro~rtg mu~t b~ drawn on diagram which i~ part of thi~ application. e. Th~ ~ork co~er~d b~ this a~pfication ma~ not be commen~d befor0 issuance of ~uildin~ Permit. d. H~on ~p~roval of thi~ a~plication, the Buildin~ Inspoctor will issue a Buildin~ Permit to the applicant. Such ~rm[t shall b~ k~t on the ~r~mis~ a~ailablo for inspection throughout the work. e. ~o buildin~ shall ~ occupied or used. in whol~ or in ~art for ang ~urpose what0~r until a Certificate of Occupane~ ~hall ha~e been~ ~rant~d ~ tho Buildin~ Ins~ctor. ~P~klC~TIO~ IS H~fiBY M~fi to th~ BuHdin~ Department for th~ i~suance of a Buildin~ Permit pursuant to the ~uildin~ Zon~ Ordinanc~ of the lown of Southold, Suffol~ Count~ ~e~ York, and ot~r applicable kaws, Ordinance~ or ~flulations, ~or the eon*truetion of buildings, addition~ or alterations, or for romoval or d~molition, as h~rein described. The applicant a~rees to complg with all a~plicable laws, ordinan~,, buildin~ code~ hou~in~ codo, and regulations, and to admit authorized inspectors on premises and in buildings for no~ar~ inspections. .......................................................... ~ [~na~f applicant, or name, if a cor~oration} StatO whether applicant is owner, Ieee, a~ent, architect, enflin~r, ~eneral contractor, electrician, plumbor or builder. Builder Name o~ owner of premiss ...~.~&~ ................................................................................................................. I~ ~icsn~ is ~ corporate, s~ns~ure ~ duly authorized officer. ............... r ............. ~ ~ (Name ~nd rifle of corporate officer) ~ ~c~ W~doloski Assis~t Vice President 1. Location of land on~-~!which propx~d work will be done. Map No.: .................... Lot No ............................................. Street and N~mber ~.~.......~.~.....~~~.~~.. ............................. 2. State existing use and occupancy of premises and intended use and occupancy of propose~construction: a. Existing use and occupancy ........... .~.i~.~A~...t...T..,~..r)..d.. ................................................................................................ l~roDosed House x~ b. Intended use and occupancy ~-- 3.~ Nature of work (check which applicable): New Building 3c~ ....................... Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) 4. Estimated Cost ..... ..~.. ]...~ ~ ..~...~...~. ............. Fee ................................................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ........ ,[ ...... Number of dwelling units on each floor ........ 1 ............................... If garage, number of cars ............... Q .......................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ........... ~/..~ ................. 7. Dimensions of existing structures, if any: Front .....................Rear ........................... Depth ................................... Height ........................................................... Number of Stories ......................................................... .................. .. Dimensions of same structure with alterations Or additions: Front .......................... Rear ......................................... Depth ............................................. Height ......................................... Number of Stories ........................................ 8. Dimensions of entire new construction: Front ....... .~1~.~ ............ Rear ............ .~,1~! .......... Depth ....... ~.4.~. ................... Height ..................... .[..5..~. ...................... Number of Stories ..... ~.. ................................................................................. 9. 'Size of lot: Front ....5~o.Q;[,f,e~t, ............. Rear ...~;~..~.~[~J~.! ................. Depth ...~,~9~52~! ................................. Height .................................................... Number of Stories ...................................................................................... 10. Date of Pumhasa ..................................... Name of Former Owner ............................................................................ 11. Zone or use district in which premises are situated ................... ; ................................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: 13. Will lot be regraded ~~ ............... Will excess fill be removed from premises: [ ] Yes ~ No 14. Name of Owner of prem~-~s .~J~;[~,e~.~trl:~/tt,..~D~;.~,~;~]~.~].~nh.8.,[a;t,.~t3J;c~ue ......... .~3.4=§~-~.~ ............. (Address) (Phone No.) Name of Architect ....... ~r~d~s~t~e~r~9~F~~v~~ .................. .~.~=~.~..3.~ ............. (Address) (Phone No.) Name of Contractor ....['~¥.~.3;~],f~.,.,~i33,~,~,....~c..,...~.~,~9..'~.,..~aJ.p.,..~e~he~ ........... ~[3.~/.=339,5. ............. (Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate ali sat-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate wheth- er interior or corner lot. SEE ATTACHED STATE OF NEW YOuR ,~,~,,j~ .................................... _/~'~-d~'..~.~..-. being duly sworn, deposes and says that ~ is the appli~nt above named. (Name ~i~iv~ si~i~g con~act) He is the ................... Z~-~---(--~ ................................................................................................................... ~ (Contractor, agent, co.orate o[ficer, etc.} of said owner or owners, and is duly authorized to ~rform or h~$l~rfo~he said work and to make and file this application; that all statements contained in this application are true to the ~s~8~sPE~°[~Y~[;..~ ~ .~-~ and that the work will be ~ormed in the ~nner set forth in the application filed therewit~ ........................ o, ........... . ............................... SUFFOLK COUNTY DEPARTMENT OF HEALTH APNJiCATiO~ FOR APPROFAL TO CONSTRUCT PRIVATE ,3~AGE DIS~SAL SYSTE~Da Apsrov~! to cons~ct said systems is requested,pertinent data herewith: 1-Applicant ~ ~~ Phone 6-Sub 9-Private we~ ~ /,'.~Ha~f~~ ~ott~T~ To~ _~'~ ~'~i~.o ..... ~-P~'sli~ w~ter supply name Distance to nearest, main --Eot Size. Width ~ ft. Length/~ft. (also enter on center plot pica = l~in=: Single Family ~ Two Family? / /Cellar? ~/Slab. ~ ~Cra~a ~O-~ro~sed system: Septic tank /~/Precast ~C~ ~spools ~/Shallow pools !l-Seotic ta~ inside dimensions: Vol~e~als. ~ ength___ft. 7cta] blocks below inlet:~--~l '~2 PLOT PLAN --~Tn nk ~ Tank ~,,e Undersigned C~RTIF]ES: "Construction ot authorized ins6allations ',~ -~-~-~ with the 3uF6olk Counby Health De~r6ments' cur?ent Stand~s~ Bu' thereto, coverind ]~R HEAESN D~PART~EkT ,UsE ONLY. Based on the ~nformation presented herewith, op2nion of the Health De~ttment, that an adequate and satisfactoU ~ , o e~-.a ge Disoos~l ca~ be installed on this Plot, ~ o. ~evis.) S-i~ JEFFI~ E Y /Y/AP OF: PtP. OPEIiiTF 6MITH CClT'Ci.-1050'~', N. ~ SUFFOLK COUNTY HEALTH DEPARTMENT OCT 3 0 1972 fgcilitJ, es for the Structllro l~.'gtod 8t found to be~sfa~tor~, Chief of THE NEW YORK BOARD Of FIRE IJNDERWRITERS BUREAU Of ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YOR~ 10038 CERTIFIES]'~[OV0~b~THIkT ~' ~72 4pplicatlonNo. o. file N Jeffer;~ Smith, e/s Fleets Neck Rd. 170' n/o Willow St , Cutcno u~:, ~v ,~. outside ""~"'"'"~"'"~"" October ~0~ ~2 at,d.ft,,,.tdt,l~e ~' t~l, llattct.,cithtl~,,r,,q,tir,.t,,t,,,t~qftl, i~lt,,.r,i. D"YERS ~ FURNACE ~OTORS ] FUTURE APPLIANCE FEEDERS~IALREC'P~J-~EC[O}K5 r -.~,. -~UNI~HEATERS 33 Lincoln Ave. Mastic Beach, N.Y. 11951 ~, ~c~-t~cote must not be ~lt~d ~n any monner; return to the office of the Boord if ~ncorred Inspectors m~y ,.,k 4¸: % t